Provider Demographics
NPI:1861284796
Name:CONJURE SERVICES AND SUPPORTS
Entity type:Organization
Organization Name:CONJURE SERVICES AND SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, IBA
Authorized Official - Phone:908-420-7595
Mailing Address - Street 1:5304 GANNET LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-9719
Mailing Address - Country:US
Mailing Address - Phone:908-420-7595
Mailing Address - Fax:
Practice Address - Street 1:5304 GANNET LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-9719
Practice Address - Country:US
Practice Address - Phone:908-420-7595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities